Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

[Sharky]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

In light of these developments, how are you guys feeling about the CDC's assurances that "We don't need a travel ban." Those of you who've defended the lack of a travel ban, here in this forum, are you still as confident as you were?

I've never agreed with the "we don't need a travel ban" idea, and nothing has changed. We do need a travel ban; we should ban commercial passenger air travel, and rely on private emergency medical flights to transport people who have been exposed, when needed.

To help enforce the ban, we should refuse visas to people traveling from affected regions.

This would not affect freight, shipment of medical or relief supplies, and so on.

We should also quarantine people who may have been exposed, or who are traveling from affected regions, until the incubation period is over -- just like we do already for certain animals.

Quarantine and containment played an effective and important role in the elimination of smallpox, and was used even with Variola Minor, which had a CFR of "only" 1% or so. Contrary to the CDC's political game-playing, there's no reason to believe a similar approach wouldn't be effective here.

 

[Sollydog]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

One of the (smaller? IIRC) MSF centers was going through 8K Euros ($10,500 USD) of PPE a day to do things the 'right' way.

I too read that and went looking for the article this morning but could not find it. One thing that makes a difference is that in West Africa they are laboring under intense heat and humidity and several bloggers from MSF have mentioned that they can only stay in the wards for about 20 minutes before the risk of fainting from the heat becomes a problem. I don't know just how many people/sets of gear that 10 grand covers but it is for an entire facility, perhaps including the workers who were dealing with digging graves and burying bodies one by one in the earlier stages of this outbreak.

In US hospitals that would be less of a problem and perhaps the HCWs can work for somewhat longer stretches of time, thus resulting in fewer sets of PPE per day.

 

[ming]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

Absolutely. This has changed her life, she might not want to go back to nursing again. I hope she gets loads of support.

 

[Dani]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

CDC Head Criticized for Blaming Nurse's Infection on "Protocol Breach".

"You don't scapegoat and blame when you have a disease outbreak," Bonnie Castillo of National Nurses United told Reuters Sunday. "We have a system failure. That is what we have to correct."
....
Texas and CDC officials say that the nurse was wearing the recommended personal protective gear for handling an Ebola patient, including a gown, gloves, mask, and eye shield. However, one expert told Reuters that gear only offers a minimum amount of protection, especially when the disease enters its final phases.

Sean Kaufman, president of an Atlanta-based firm that helps train hospital staff said that caregivers may need to add more layers of protection in the patient's final days, such as double gloves, a respirator, or even a full bodysuit.

 

[WTB]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

With this disease, at the end stage, the principal view of action should be to protect medical personnel, as the patient is likely to die and is very very infectious. The problem is Not the amount of PPE it is how it is used. And we see the more " breech" during extremelly hasardous medical technique ( intubation) and when personnel take PPE out. I think those personnel should be helped and supervised every day by infection control specialist, to help them stay focus on techniques. Also medical decision should be balanced to protect personnel as much as "saving" the patient.
Also having one patient under medical care like in USA and Spain, you can be more protective and have a more strict protocole. The same protocole couldn't be apply if you have to treat hundred or if it 40 degres Celsius ...

 

[AnnaLisa]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

If we do have to treat hundreds or thousands of patients with Ebola in the US, the heath care system will start to feel the weight due to the cost of PPE if we move up to the correct gear, which is similar to what MSF is using. I think that the CDC underestimated the difficulty and cost of caring for Ebola patients in this country. I think that they underestimated the type of gear required. From what I have read, MSF does reuse major portions of their gear after it is sanitized (yes, one more place that protocol can break down), but, it may provide the best safety for the HCW while keeping it within budget.

As a nurse, I don't think we can't treat this like it's MRSA, which is bad enough. This is a fatal disease at least half the time. We need Tyvek suits, a decent hood or head protection that is waterproof, good googles, preferably tight, sealed googles or a full sealed facemask, at minimum a N95 respirator mask, and I would feel better if that N95 had a secondary surgical mask over it to protect that mask if a full face mask was not used. To be honest, I would feel better with a HEPA system PAPR. I would wear 2 pairs of gloves under a third thick pair of 'household' type gloves. I would wear an apron over my Tyvek suit. I would wear booties under my Tyvek suit, then booties over my Tyvek suit, then a pair of rubber boot over that. Underneath it all a full set of long sleeve scrubs. We need a buddy to help us don and doff and a shower after each doffing.

This isn't cheap. Given most hospitals are private and have to generate money, this is going to take a huge bite out of their operating budgets. These are high maintenance patients.

HCW especially nurses and doctors are going to have to be protected or there will not be personnel to care for any one, Ebola or not.

Consider that most HCW go home to a family after their shift. How much can we ask them to risk?

 

[erruve]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

Would it help if the states all had the ACA in place and this was a covered protocol? Do we need to bring congress back to work on infectuous disease act and funding?

 

[Zac]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

We need Tyvek suits, a decent hood or head protection that is waterproof, good googles, preferably tight, sealed googles or a full sealed facemask, at minimum a N95 respirator mask, and I would feel better if that N95 had a secondary surgical mask over it to protect that mask if a full face mask was not used. To be honest, I would feel better with a HEPA system PAPR.

They should be using full body suits with a full hood. A PAPR like battery powered blower should be used for comfort. The manufacturing cost of this gear is not very high.

 

[AnnaLisa]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

While the ACA would insure people, it is the simple cost of equipment and time involved. It doesn't matter which entity is paying for it, ultimately it will result in higher costs.

Yes, HCW need training, absolutely, but if the gear is insufficient, that is a problem.

They can't go cheap on the gear. I suspect that this is where the hospitals are trying to save money.

I think that we do need a few Ebola centers in each region. I believe that once Ebola becomes more common, and we see more and more cases, it will be better to have hospitals that take care of patients who do not have Ebola or patients are going to be reluctant to come to the hospitals. Health care is a huge percentage of our GDP.

 

[Chicagogal]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

This isn't cheap. Given most hospitals are private and have to generate money, this is going to take a huge bite out of their operating budgets. These are high maintenance patients.

I am baffled as to what has happened to all the HPP grant money hospitals received after 9/11 for disaster and pandemic flu preparedness. There were BILLIONS given to virtually all hospitals in this country. Where are all the supplies that were purchased?

http://fas.org/sgp/crs/homesec/RL34190.pdf

 

[erruve]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

I am baffled as to what has happened to all the HPP grant money hospitals received after 9/11 for disaster and pandemic flu preparedness. There were BILLIONS given to virtually all hospitals in this country. Where are all the supplies that were purchased?

http://fas.org/sgp/crs/homesec/RL34190.pdf

Funding for everything has been cut dramatically according to the NIH. Maybe the issue is to simply restore past funding leveles and increase it. Apparently, NIH thinks they lost more than 2 years in research time and would have had a vaccine now, but not for sequestration.

 

[Chicagogal]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

Yes, funding has been cut, but these HPP grants were straight up gifts from the federal government. This money was never in the run rate for hospitals - it was earmarked specifically for PPE for pandemics and disasters.

I looked it up - we have given eight billion dollars since 9/11 to hospitals for this. Every hospital was required to develop a pandemic flu plan by 2005, and to purchase specific equipment/implement training with this money.

 

[AnnaLisa]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

I think there is a deep denial even among the educated.


Allowing unmitigated worldwide travel and hoping that we will catch every ember is asking for a wildfire.

 

[Lizw]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

This isn't a small hospital, though. It has 900 acute care beds! That's huge. There are whole states that don't have that many beds. And it's a private nonprofit hospital, which typically have absolutely anything anyone could want right at their fingertips, with well-trained staff. I believe it's ranked as one of the best facilities in Texas. So it's not an understaffed, overworked public hospital. That's what makes this so worrisome, these guys should have been able to handle it.

My comment was not about Texas Presbyterian, but in reply to Frieden's statement that "any hospital could manage with appropriate procedures." While on the face of it, that is certainly true, my experience with both large non-profit hospitals similar to Presbyterian and with smaller rural and urban hospitals has shown me that appropriate procedures are often not followed. I'm not going to call names--there are too many complex reasons, both financial, managerial and simply human reasons why known proper procedures aren't always observed. This is not a rant against health care workers, btw. I was one of them, and I know how easy it is to pass the buck and blame the people actually doing the scut work. I just don't share Frieden's faith that everyone is always going to do the right thing.

 

[AlaskaDenise]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

Are you talking about ebola virus particles riding in from West African on an import from West Africa? That's an extremely unlikely scenario and quite a stretch. I'm talking about limiting the single most effective transporter of ebola virus into the U.S.: human beings.

Consider the airplane crews.

.

 

[oldman]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

Winter + influenza + enterovirus + ebola......How will our overworked HCW's be able to determine who has the flu vs ebola? Will the funded resources become exhausted by not being able to determine who has an infection that requires the use of PPE? How will the HCW's know if they are getting the truth after asking the screening questions? How will the hospitals be able to handle critically ill patients waiting for the test results? My point is that there must be some "looking forward" planning is essential with winter coming on. If I missed something, please chew me out!